Unfortunately, changes in the health care system, such the Affordable Care Act (Obamacare) have affected coverage. Fortunately, New Jersey state employees and most NJ teachers continue to be covered under the mandate. There are some gaps in this coverage, particularly for single women and those in single sex/lesbian relationships.

With an act of the NJ state legislature and the signature of Governor Christie, that has changed. The infertility mandate has been updated to reflect the new ASRM definition of infertility and includes the following:

A male is unable to impregnate a female;

A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse;

A female with a male partner and 35 years of age and over is unable to conceive after 6 months of unprotected sexual intercourse;

A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of IUI (intrauterine insemination) under medical supervision;

A female without a male partner and over 35 years of age who is unable to conceive after 6 failed attempts of IUI under medical supervision;

Partners are unable to conceive as a result of involuntary medical sterility;

A person is unable to carry a pregnancy to live birth; or

A previous determination of infertility pursuant to the law.

This update in coverage becomes effective in August 2017 and only applies to New Jersey state employee and teacher plans.

At Princeton IVF, we participate in the affected New Jersey State Health Benefits Program and School Employees Health Benefits Plan that are affected by these new rules, including NJ Direct from Horizon Blue Cross Blue Shield and Aetna for NJ state employees.

YOUR HEALTH: Infertility: causes and solutions

This article recently appeared in the Health Matters Column of the Princeton Packet...

So You Want to Have a Baby?

Infertility is defined as the inability to conceive after engaging in unprotected sex for one year, according to the Centers for Disease Control and Prevention.

What causes fertility problems?

It can be a number of factors. Dr. Seth Derman of Princeton IVF and Delaware Valley OBGYN, said that approximately 40 percent of the fertility issues he sees are due to male problems, 40 percent are due to female problems, and 20 percent a combination of both partners.

”The exact cause of male infertility is a little harder to diagnose because it’s not well understood,” Dr. Derman said. “With female infertility, the most common cause is ovulation problems, which usually show up as irregular cycles. Polycystic ovarian syndrome is the most common of these.”

Fertility problems can be caused by endometriosis. They also can be linked to damage to the fallopian tubes, which can be caused by previous sexually transmitted diseases. This is particularly a problem in women who have had prior Chlamydia infections.

And sometimes infertility has no identifiable cause.

What options exist for treatment?

”Well, it depends what’s wrong,” Dr. Derman said. “If there’s an ovulation problem, usually the treatment is fairly simple with fertility drugs. These are medications that induce ovulation, such as clomid or letrozole.”

”For tubal problems — the treatment is usually surgery or IVF (in vitro fertilization),” Dr. Derman said. “IVF is clearly the most effective treatment for these problems.”

Oftentimes the most effective option involves treating the female partner. IVF allows for the sperm to be injected directly into the egg, and is the most effective treatment for male infertility. “The poorer the husband’s sperm the more likely the couple will need more invasive treatment such as IVF,” Dr. Derman said.

A less invasive alternative to IVF is insemination, in which sperm is injected up into the uterus. In contrast, IVF involves fertilization of the egg outside of the body, and the transfer of that embryo into the woman’s womb. It is also much more effective than insemination. When patients have unexplained infertility, insemination is oftentimes done first, and if that doesn’t work then they may try IVF, Dr. Derman said.

What are the odds of success?

Typical fertile couples have a 20 to 25 percent chance of getting pregnant each month. Infertile couples have a 3 percent chance when trying on their own. IVF increases the odds of having a child to twice what it would be in a fertile couple. Those numbers can vary based on age.

IVF is very often successful in the first or second cycle, particularly in young women. If it isn’t successful, it’s not unusual for a couple to try three or four times, according to Dr. Derman.

Who pays for IVF?

In New Jersey, the Family Building Act (August 2001) requires companies with more than 50 employees to cover fertility testing and treatment, including IVF. There are exceptions in the law, and since the passage of healthcare reform, those exceptions have gotten even larger.

Some of the other treatments can be relatively inexpensive. “For instance, treatment using fertility pills and some monitoring is not terribly expensive,” Dr. Derman said.

When should you go see a fertility doctor?

”Generally, over 35, we recommend coming after six months,” Dr. Derman said. “If they are under 35, one year is the right time.”

What should you expect when you go see a fertility doctor? When patients go to see Dr. Derman for the first time, the first stage in the process is to try to understand why they are unable to conceive. After getting a detailed history, tests will be ordered, which include testing to make sure their eggs are not running out, to make sure their tubes are open, to make sure the ovulation process is going well and that the sperm is normal. After getting a clearer picture of what is going on, they can better determine the next steps.

”Not everybody with infertility needs IVF, even though it is the most effective treatment out there,” Dr. Derman said. “IVF is the last thing that we do, not the first thing.”

After faithfully serving our country in Iraq and Afghanistan, many of the brave men and women of our armed forces return home with injuries. While the more devastating injuries such as head injuries, missing limbs and PTSD, make all the headlines, there are other battle scars that remain unspoken. One of those is infertility.

Serving our nation can have an adverse effect on couple's ability to start or grow a family, whether it be from the direct trauma of battle or the inevitable delays that come from prolonged deployments. Appropriately, the Defense Department recognizes the importance of this for our fighting men and women and provides at least some fertility coverage for active service personnel.

The same is not true for our veterans. In fact, federal law prohibits covering these treatments through the VA system. On several occasions, Senator Patty Murray (D-Washington) has introduced bills to address this issue without success. Now, there is also movement on the other side of the aisle. Just this past week, Representative Jeff Miller (R-Florida), Chairman of the House Committe on Veterans Affairs has introduced a bill to correct this inequity. His bill HR 2257, if passed and signed into law, will allow veterans to treat fertility issues that arose during their service even after they leave the armed forces. Hopefully, this legislation will make it through the congress and on to the President's desk.